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    Acetaminophen reduces acute and persistent incisional pain after hysterectomy
    (Edizioni Luigi Pozzi, 2018) Koyuncu, Onur; Hakimoglu, Sedat; Ugur, Mustafa; Akkurt, Cagla; Turhanoglu, Selim; Sessler, Daniel; Turan, Alparslan
    OBJECTIVE: Acetaminophen is effective for acute surgical pain, but whether it reduces persistent incision pain remains unknown. We tested the primary hypothesis that patients given perioperative acetaminophen have less incisional pain three months after surgery. Our secondary hypotheses were that patients randomized to acetaminophen have less postoperative pain and analgesic consumption, and better functional recovery at three months. METHODS: 140 patients having abdominal hysterectomy were randomly assigned to: 1)intravenous acetaminophen (4 g/day for 72 postoperative hours); or, 2) saline placebo. The primary outcome was incisional pain visual analog scale (VAS) at three months after surgery. The secondary outcomes were (1, 2) postoperative VAS scores while laying and sitting and (3) total patient-controlled intravenous tramadol consumption during the initial 24 hours, (4) DN4 questionnaires and (5) SF-12 at three months after surgery. RESULTS: The persistent incisional pain scores at three months were significantly lower in acetaminophen (median [121, Q3]: 0 [0, 01) as compared with saline group (0 [0, 1]) (P = 0.002). Specifically, 89%, 9%, and 2% of acetaminophen patients with VAS pain score at three months of 0, 1, and 2 or more, as compared with 66%, 23%, and 10% in the saline group (odds ratio: 2.19 (95% CI: 1.33, 3.59), P = 0.002). Secondly, postoperative pain scores both laying and sitting were significantly lower in the acetaminophen group. Acetaminophen group had significantly better DN4 score and mental health related but not physical health related quality of life. CONCLUSIONS: Our results suggest that acetaminophen reduces the risk and intensity of persistent incisional pain. However, there are other mechanisms by which acetaminophen might reduce persistent pain.
  • Küçük Resim
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    The effect of ondansetron on analgesic efficacy of acetaminophen after hysterectomy: A randomized double blinded placebo controlled trial
    (Elsevier Science Inc, 2017) Koyuncu, Onur; Leung, Steve; You, Jing; Oksar, Menekse; Turhanoglu, Selim; Akkurt, Cagla; Dolapcioglu, Kenan
    Objectives: To determine that perioperative ondansetron reduces the analgesic efficacy of acetaminophen. Design: Randomized, double-blinded study. Patients: 120 patients ASA I-II who underwent abdominal hysterectomy. Interventions: All the patients were given 1 g acetaminophen at skin closure. Patients were divided into two groups; ondansetron HCI (8 mg, 2 ml IV) (Group I, N = 60) and saline (2 ml IV) (Group II, N = 60) at the skin closure. Measurement: Postoperative pain scores (VAS) while resting in bed and sitting, total opioid consumption were noted. Main results: Patients randomized to ondansetron had significantly worse pain scores upon arrival to the recovery unit [by 1.7 (99.7% CI: 0.75, 2.59) cm] and at 1 h [by 13 (0.5, 2.1) cm] while resting in bed. Pain scores while sitting were also significantly greater in ondansetron group at arrival in PACU by 0.6 (99.7% CI: 0.1, 1.0) cm. Thereafter, pain scores did not differ significantly. Median total opioid (tramadol) consumption was 441 [QI, Q3: 280, 578] mg in the ondansetron group and 412 [309, 574] mg in the placebo group, P = 0.95. Conclusions: Ondansetron significantly decreased the analgesic effect of acetaminophen during the initial postoperative period. Our results thus confirm that acetaminophen analgesia is partially mediated by serotonin receptors. However, the reduction was of marginal clinical importance and short-lived. (C) 2017 Elsevier Inc. All rights reserved.